Basic Information
| Provider Information | |||||||||
| NPI: | 1518442144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAVAGE | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | LEESHUN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5628 E SLAUSON AVE | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900402922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239189960 | ||||||||
| FaxNumber: | 3237803211 | ||||||||
| Practice Location | |||||||||
| Address1: | 5628 E SLAUSON AVE | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900402922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239189960 | ||||||||
| FaxNumber: | 3237803211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2018 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.